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Physician adoption

FrontPage => Building Blocks

 

Physician adoption


General

 

Critically important for the success of CPOE.  It is affected by presentation of orders and information.  The challenge is to get everyone on board especially those who use different systems and who work in different ways.

 

For CAHs, you want to keep the physicians who have been there for a while and do not wish to chase them away.  However it really comes down to strong leadership with everyone on board.

Optimizing System access

Access

Single sign-on

Plenty of workstations

Appropriately configured workstations

Well maintained with fast processors / network and ample memory

Remote access

Point of care strategy

giving the physican easy access each time they need to use a workstation

Choices in devices

          wired / Wireless

Computers on wheels / iPad

Discussion of the pros and cons of the different tools

Quiet working areas for chart review / data entry

Hospitalists have a different need - especially need a quiet zone for their dictations and entering orders, pacs, They also tend to fine a quiet place from which they will do most of their work

Training

Dedicated physician trainer that also provides support

Residents have been trained in groups - more comfortable that way

Attendings are trained one-on-one.  Especially during the early days 2 - 4 hours anytime any day away from the unit and away from the practice.  Office managers will help arrange times.  Needs to be trained on their specialty need.

Support

Robust plan that includes trainers superusers 24x7 helpdesk who are qualified to answer physician questions with fast replies / answers

24x7 Needs to be in person during implementation (command center mentality)  May back off when other users are available to provide support.

Prompt response to requests for change.  Avoiding the black-hole syndrome.  With reasons for the change / no change that closes the loop.

Involvement with the implementation

Working with the providers throughout the build helps them attain ownership

Communication

Building the burning platform - see communication - why we are doing this

Evidence that CPOE improves quality safety etc.

Be truthful about how it will not save time.

However, pre and post shadowing showed quicker turn around time in orders.

Bring in advocates / peers from other departments to meet with them and see how it can work for them

Policies

that suport adoption - will you permit the use of verbal orders.  Important to support nursing so they do not feel like they are going to have an increase of work / verbal orders.  If not it can be a barrier for nursing to support CPOE.  Expectation that VO are only for ungency orders.  TO is where there is no access to computer systems.

Policy for alerts that occur during entery of VO / TO.  Suggestion VO - Pharmacy TO - doc stays on the phone.

Metrics

On adoption

on verbal orders

 

Tools

"A Structured Approach to Physician Adoption of Technology" Barbara A. Crowell, Dearborn Advisors, LLC http://www.dearbornadvisors.com/docs/Phys_Adopt_crowell.pdf

 

"Improving Physician Adoption of CPOE Systems" Scott R. Fisher, M.D.; Jean-Paul Creusat, M.D.; D. Andrew McNamara, M.D.  Clinical Consulting Services, McKesson Provider Technologies

 

Top 10 Hospital-Physician Health IT Engagement Strategies 

Edna Boone, HIMSS, Ben Brown, KLAS and William Young,Berkshire Health Systems

 

Studies

A Time-Motion Study to Evaluate the Impact of EMR and CPOE Implementation on Physician Efficiency

Amen A. Amusan, PMP, MS; Scott Tongen, MD; Stuart M Speedie, PhD; and Andrew Mellin, MD, MBA, Journal of Healthcare Information Management — Vol. 22, No. 4

 

Stories

Decrease in mortality associated with physician order entry system

  • Researchers at Lucile Packard Children's Hospital and Stanford University School of Medicine have shown for the first time that a significant decrease in hospital-wide mortality rates can be associated with implementation of a computerized physician order entry system. Pediatrics 2010 Jul;126(1):14-21

 

 How to implement CPOE successfully at your Hospital by John Halamka, MD

 

You've Led the Horse to Water, Now How Do You Get Him to Drink: Managing Change and Increasing Utilization of Computerized Provider Order Entry

Donald Levick, MD, MBA, Harry F. Lukens, and Paula L. Stillman, MD, MBA, Journal of Healthcare Information Management — Vol. 19, No. 1